The intraoperative use of internal iliac artery balloon catheters in cesarean deliveries for abnormal invasive placentation: A 3-year retrospective cohort review in Doha, Qatar.

BACKGROUND: Abnormal invasive placentation leads to massive intraoperative hemorrhage and maternal morbidity. This study aimed to assess the impact of the preoperative use of internal iliac artery balloon occlusion (IIABO) catheters in patients who had a cesarean delivery (CD) for invasive placentation, commonly known as the placenta accreta spectrum. METHODS: This retrospective cohort study reviewed 67 pregnancies complicated by abnormal invasive placenta and confirmed intraoperatively. Preoperative planned placement of IIABO was performed in 33 women who underwent elective CD. Senior Obstetricians with the necessary expertise performed all CDs. The primary outcome measures were: intraoperative blood loss, blood transfusion requirement, duration of surgery and the need for hemostatic measures. Univariate comparison between the groups and regression analysis of the primary outcome and controlling for confounders, were performed. RESULTS: No statistically significant difference was observed between the groups with intraoperative hemorrhage volume of above 3000 mL (unadjusted odds ratio [OR] 0.94 [no-IIABO group as the reference]; p = 0.895) and the median duration of surgery (median 107, interquartile range [IQR] 80-135 vs. median 96, IQR 75-121; p = 0.3508). More than 40% of the IIABO group required intraoperative transfusion of packed red blood cells above six units (14 [42.4%] vs. 10 [29.4%]; p = 0.357]), and 30% required additional postoperative transfusion (10 [30.3%] vs. 8 [23.5%]; p = 0.706]), although not statistically significant. Multivariate logistic regression analysis showed that the difference remained nonsignificant after covariate adjustment (adjusted OR 0.585, p = 0.456). Cesarean hysterectomy was performed in fewer cases (seven [21.1%]) in the IIABO group than in the no-IIABO group (10 [29.4%]), although this difference was not significant (unadjusted OR 0.65, p = 0.442). CONCLUSIONS: The placement of IIABO catheters is an invasive procedure, which consumes time and resources. Its value as a means of reducing intraoperative blood loss or preserving the uterus in patients with abnormal placental adherence appears questionable. In this cohort study, there was no statistical difference in blood loss, and the need for other steps to control hemorrhage between women with and without IIABO catheters.

Control of postpartum hemorrhage in women with placenta accreta spectrum using prophylactic balloon occlusion combined with Pituitrin intra-arterial infusion.

OBJECTIVES: The aim of this study is to evaluate the efficacy of prophylactic internal iliac artery balloon occlusion combined with Pituitrin intra-arterial infusion in the control of postpartum hemorrhage in women with placenta accreta spectrum (PAS). METHODS: This is a prospective and non-randomized controlled study. The participants were assigned into three groups: without balloon catheterization (non-BC) group, balloon catheterization (BC) group, and Pituitrin combined with balloon catheterization (PBC) group. The primary outcomes were estimated blood loss (EBL) and the units of transfused packed red blood cells (PRBC). The secondary outcome was the incidence of hysterectomy. RESULTS: A total of 100 participants were recruited between August 2013 and November 2018 and assigned into the respective groups as follows: 27 in the non-BC group, 22 in the BC group, and 51 in the PBC group. No statistical differences were found in demographic characteristics among the three groups. There was a trend of lower EBL, PRBC, and hysterectomy rate in the BC group than those in the non-BC group, while all values showed no significant differences (all p > 0.05). Patients in the PBC group had significantly lower EBL, PRBC, and hysterectomy rate compared with those in the non-BC group (all p < 0.05). Linear regression analysis revealed that the PBC (vs. others) was negatively correlated with EBL and the non-BC (vs. others) independently predicted more EBL. CONCLUSIONS: Balloon occlusion combined with Pituitrin infusion is an effective treatment method which significantly reduced EBL, PRBC, and hysterectomy rate in patients with PAS. KEY POINTS: • Internal iliac artery balloon occlusion combined with Pituitrin intra-arterial infusion can significantly decrease EBL, PRBC, and hysterectomy rate during cesarean section in patients with PAS. • Cesarean section without balloon occlusion and placenta accreta depth are two independent risk factors for EBL in patients with PAS.

Comparison of infrarenal aortic balloon occlusion with internal iliac artery balloon occlusion for patients with placenta accreta.

BACKGROUND: The study was designed to compare the role of infrarenal aortic artery balloon occlusion (IAABC) with internal iliac artery balloon occlusion (IIABOC). METHODS: One hundred seventy-four cases with placenta accreta were retrospectively analyzed.74 cases who had IAABC were in group A, while the others who had IIABOC were in group B. RESULTS: Amount of estimated blood loss (EBL), the rate of major blood loss, the rate of blood transfusion and uterine packing, length of hospitalization were not different in both groups. The rate of uterine artery embolization (UAE), balloon occlusion time, operation time and fetus radiation dose in group A were less than those in group B. CONCLUSIONS: IAABC resulted in better clinical outcomes than IIABOC.

Analysis of the Risk Factors for Massive Hemorrhage in Pernicious Placenta Previa and Evaluation of the Efficacy of Internal Iliac Artery Balloon Occlusion.

Objective: To investigate the risk factors of intraoperative massive hemorrhage in patients with pernicious placenta previa (PPP) and analyze the value of bilateral internal iliac artery balloon occlusion in Cesarean section for these patients. Methods: The clinical data of 134 patients with PPP admitted to the Second Hospital of Shanxi Medical University from January 2012 to January 2019 were analyzed. A logistic regression analysis was used to analyze the risk factors for intraoperative massive hemorrhage in PPP. The study subjects were divided into the intervention group (38 cases) and the routine group (96 cases) according to whether bilateral internal iliac artery balloon occlusion was conducted during the operation. The differences in some clinical indicators were compared between the two groups. Results: The risk factors for intraoperative massive hemorrhage in PPP were age ≥35 years, gestational age ≥34 weeks, complete placenta previa, and the presence of placenta accreta. The differences in the operation time, postoperative transfer to the intensive care unit, postoperative length of the hospital stay, and neonatal weight and score were not statistically significant between the intervention group and the routine group (P > 0.05 for all). While the intraoperative blood loss and the transfusion volume in the intervention group were lower than in the routine group, the hospitalization cost was higher in the former than in the latter, and the differences were statistically significant (P < 0.05 for all). Moreover, there was no case of hysterectomy in the intervention group, while there were two cases of hysterectomies in the routine group. Conclusion: The risk factors for intraoperative massive hemorrhage in PPP were age ≥35 years, gestational age ≥34 weeks, complete placenta previa, and the presence of placenta accreta. Internal iliac artery balloon occlusion during PPP could reduce intraoperative blood loss and the hysterectomy rate.

Comparison of emergency cesarean hysterectomy with and without prophylactic placement of intravascular balloon catheters in patients with placenta accreta spectrum.

OBJECTIVE: The objective of the study was to compare outcomes of women with placenta accreta spectrum(PAS) who underwent emergency cesarean hysterectomy with and without prophylactic intravascular balloon catheters.Methods Sixty-three cases who had emergency hysterectomy related to PAS disorders were retrospectively analyzed. Subjects with prophylactic intravascular balloon catheter placement plus hysterectomy were compared with those who had hysterectomy alone. The cases were divided into three groups: infrarenal aortic artery balloon occlusion (IAABC) group (who had IAABC plus hysterectomy, n = 31), internal iliac artery balloon occlusion (IIABOC) group (who had IIABOC plus hysterectomy, n = 17), and hysterectomy alone group (control group n = 15). RESULTS: Outcome measures were not significantly different between the IIABOC group and the control group. IAABC plus hysterectomy resulted in a better outcome than hysterectomy alone, with less amount of estimated blood loss (EBL) during cesarean section (2000 vs 3000 ml, p = .011) and 24 h after cesarean section (2010 vs 4520 ml, p = .004), less operation time(90 vs 106 min, p = .01), and a lower rate of major blood loss(42 vs 93%, p = .029). IAABC plus hysterectomy resulted in better outcomes than IIABOC plus hysterectomy, with less amount of EBL during cesarean section (2000 vs 3000 ml, p = .005) and 24 h after cesarean section (2010 vs 3000 ml, p = .035), a lower rate of major blood loss(42 vs 100%, p < .001), less operation time (90 vs 100 min, p = .038), and less fetus radiation dose（1.9 mGy vs 22.4 mGy, p < .001). CONCLUSIONS: IAABC was more effective in emergency cesarean hysterectomy related to PAS disorders.

Safety and Efficacy of Aortic Vs Internal Iliac Balloon Occlusion for Cesarean Delivery in Coexisting Placenta Accreta and Placenta Previa.

PURPOSE: To investigate safety and efficacy of intra-aortic balloon occlusion (IABO) versus internal iliac artery balloon occlusion (IIABO) for cesarean delivery in coexisting placenta accreta and placenta previa. MATERIALS AND METHODS: From 2006 to 2019, 60 pregnant women who had undergone preoperative IABO (n = 28) and IIABO (n = 32) for cesarean delivery in coexisting placenta accreta and placenta previa were retrospectively identified, and their medical records and relevant imaging were reviewed. RESULTS: Maternal characteristics (age, gravidity, previous cesarean delivery, gestational age, and neonatal weight) were similar in both groups. Estimated blood loss, volume of blood transfusion, length of hospitalization, and rate of hysterectomy were not significantly different between the groups. Operation time (the duration of cesarean delivery and hysterectomy, p < 0.05), total time of balloon occlusion (p < 0.01), and fetal radiation dose (p < 0.001) in the IABO group were less than in the IIABO group. No severe complications related to the balloon occlusion procedure were noted in either group. CONCLUSION: IABO and IIABO are safe and effective options for cesarean delivery in patients with combined placenta accreta and placenta previa. The average operation time, balloon occlusion time, and fetal radiation dose in patients with IABO are less than in patients with IIABO. There were no complications related to balloon occlusion of the aorta or internal iliac artery.

Recurrent severe placenta increta at 8 weeks of gestation in a twin pregnancy following uterus-conserving surgery for prior placenta accreta spectrum disorder.

OBJECTIVE: We describe herein our experience of employing a hysterectomy and prophylactic internal iliac artery balloon occlusion (IIABO) strategy for the management of recurrent severe placenta increta at 8 weeks in a twin pregnancy following uterus-conserving surgery for prior placenta accreta spectrum (PAS) disorder. CASE REPORT: A 40-year-old woman with a history of uterus-conserving surgery for PAS disorder underwent transvaginal ultrasound evaluation at 8 weeks of pregnancy, which showed a dichorionic/diamniotic pregnancy with viable embryos of a crown-rump length of 1.65 cm and 2.03 cm, respectively. Many irregularly-shaped grade 3+ lacunae were observed, and color Doppler imaging revealed diffuse intraplacental and perihypervascularity. A total abdominal hysterectomy was performed at 10 weeks, with an estimated blood loss of 1275 mL. Placenta increta was confirmed by histopathologic examination. CONCLUSION: The high rate of recurrence of PAS disorder in a subsequent pregnancy should be discussed following an antenatal diagnosis of PAS disorder with patients who may be considering uterine conservation in order to retain the option of a future pregnancy.

Clinical application of prophylactic internal iliac artery balloon occlusion combined with uterine artery embolization in patients with abnormally invasive placenta.

BACKGROUND: The purpose of this study is to investigate the role of prophylactic internal iliac artery balloon occlusion combined with uterine artery embolization (UAE) in patients with abnormally invasive placenta. METHODS: Forty cases with abnormally invasive placenta who visited our hospital were analyzed retrospectively from May 2014 to September 2015. Twenty cases who had prophylactic balloon occlusion of internal iliac artery with/without UAE were in the study group, while the other 20 cases in the control group. Volume of estimated blood loss and blood transfusion, rate of hysterectomy, surgery duration, postoperative complication and length of hospitalization were compared between two groups. RESULTS: The mean estimated blood loss in the study group (800 ml,500-1800 ml) was less than that in the control group (1875 ml, 500-7600 ml) (p = .01). Only two cases had blood transfusion in the study group, while 12 cases in the control group. No case was performed hysterectomy in the study group, while one case had the operation in the control group. There was no significant difference in surgery duration, postoperative complications and length of hospitalization between two groups. CONCLUSION: Prophylactic balloon occlusion of internal iliac artery combined with UAE is effective and safe for patients with abnormally invasive placenta.

The utility and effectiveness of an internal iliac artery balloon occlusion catheter in surgery for large cervical uterine fibroids.

OBJECTIVE: Surgery for uterine cervical fibroids is difficult because of restricted surgical access and risks such as intraoperative bleeding or injury to other organs. The internal iliac artery balloon occlusion catheter (IIABOC) provides effective hemostasis for placenta previa and atonic hemorrhage, and is increasingly used in surgery for uterine fibroids for controlling intraoperative hemorrhage. We investigated the efficacy and safety of the IIABOC for controlling intraoperative bleeding in total abdominal hysterectomies (TAH) and abdominal myomectomies (AM) for large cervical fibroids. MATERIAL AND METHODS: From 2007 to 2014, the IIABOC was used in 22 cases (12 for TAH and 10 for AM) in which cervical fibroids fully occupied the pelvic cavity. Intraoperative blood loss, operating time, sample weight, use of blood transfusion, and injury to other organs were assessed. RESULT: Mean blood loss, operative time, and sample weight in the IIABOC cases were 510 mL, 178 min, and 2550 g for TAH; and 727.5 mL, 157.5 min, and 1850 g for AM. Blood loss divided by sample weight in IIABOC cases was significantly lower than that in non-IIABOC cases during the same time period, for both TAH and AM. Allogeneic blood transfusion was not necessary, and complications of injury to other organs did not occur in any of the 22 cases. CONCLUSIONS: For large cervical fibroids with limited operating space, surgery was performed under bleeding control by occlusion of the internal iliac artery with an IIABOC. This technique enables control of hemorrhage and safe operative management in gynecological surgery.